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Concept
External cephalic version
Summary
External cephalic version (ECV) is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is a manual procedure that is recommended by national guidelines for breech presentation of a pregnancy with a single baby, in order to enable vaginal delivery. It is usually performed late in pregnancy, that is, after 36 gestational weeks, preferably 37 weeks, and can even be performed in early labour.
ECV is endorsed by the American College of Obstetricians and Gynecologists (ACOG) and Royal College of Obstetricians and Gynaecologists (RCOG) as a mode to avoid the risks associated with a vaginal breech or cesarean delivery for singleton breech presentation.
ECV can be contrasted with "internal cephalic version", which involves a hand inserted through the cervix.
ECV is one option of intervention should a breech position of a baby be found after 36 weeks gestation. Other options include a planned caesarian section or planned vaginal delivery.
ECV has an average success rate of around 58%, between 40 and 64% depending on whether it is the mother's first child or not. (40% for first-time mothers and closer to 60% for women who have had previous children.
Various factors can alter the success rates of ECV. Practitioner experience, maternal weight, obstetric factors such as uterine relaxation, a palpable fetal head, a non-engaged breech, non-anterior placenta, and an amniotic fluid index above 7–10 cm, are all factors which can be associated with higher success rates. In addition, the effect of neuraxial blockade on ECV success rates have been conflicting, although ECV appears easier to perform under epidural block.
Following successful ECV, with the baby turned to head first, there is a less than 5% chance of the baby turning spontaneously to breech again.
Some situations exist where ECV is not indicated or may cause harm. These include recent antepartum haemorrhage, placenta praevia, abnormal fetal monitoring, ruptured membranes, multiple pregnancy, pre-eclampsia, reduced amniotic fluid and some other abnormalities of the uterus or baby.
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